Vitamin D Deficiency Associated with Increased Stroke Severity in Acute Ischemic Stroke Patients

by | Jan 18, 2024 | 2023, Brain Health, Stroke, Vitamin D - Recommended Levels

Written by Taylor Woosley, Staff Writer. Multivariable analysis findings show that lower serum Vitamin D levels were associated with an increased risk of stroke severity (p < 0.001) and poor functional outcomes. 

vitamin D capsulesThe incidence of cerebrovascular diseases is on the rise globally, of which acute ischemic stroke (AIS) has a high mortality, making it one of the leading causes of death1. Ischemic stroke occurs when the blood supply to a part of the brain is interrupted or reduced due to arterial blockage, often leading to damage to brain cells or death2. The risk of stroke increases with age, with approximately ¾ of all strokes occurring in people aged 65 years or older3.

In recent years Vitamin D’s possible pathophysiological role in cardio- and cerebrovascular disorders has been recognized4. Vitamin D aids in protection and recovery from ischemic stroke through the reduction of hypertension, by negative regulation of the renin-angiotensin system, and by increasing antithrombotic and neuroprotective factors5. Furthermore, the antioxidant capabilities of vitamin D, through the inhibition of reaction oxygen, can prevent blood-brain barrier (BBB) dysfunction after an ischemic stroke6.

Kim et al. conducted a retrospective study to analyze the association between serum Vit D levels and short-term functional outcomes in acute ischemic stroke subjects. Subject inclusion consisted of patients diagnosed with AIS on a brain MRI. Information pertaining to demographic data (age, sex, and BMI), medical history, and clinical data were obtained from medical records. The National Institutes of Health Stroke Scale (NIHSS) score was measured during hospital admission to determine the initial stroke severity. Mild stroke was defined as an NIHSS score <5, while moderate-to-severe stroke was defined as an NIHSS score ≥5. Blood samples were collected from all participants within 24 hours of hospital admission. Chemiluminescence immunoassay was utilized to analyze a serum total of 25-hydroxy Vit D (25-OHD). The season in which serum Vit D was measured was also considered to reflect the seasonal variation of serum Vit D levels.

Subjects partook in bedside or gym-based rehabilitation physical therapy daily during weekdays for at least 30 minutes to 2 hours. The Berg Balance Scale (BBS) was used to evaluate balance ability. The Manual Function Test (MFT) was utilized to measure upper extremity function. The Korean Mini-Mental State Examination (K-MMSE) was used to assess cognitive function. Furthermore, the Korean version of the modified Barthel Index (K-MBI) was utilized to analyze daily living performance. At subject’s discharge, the modified Rankin scale (mRS) score was evaluated to analyze functional dependency and general disability.

192 patients were included in the final analysis and were divided into 3 groups based on serum Vit D levels at admission: Vit D sufficient group (25-OHD > 30 ng/mL, n = 28), Vit D insufficient group (30 ng/mL ≥ 25-OHD ≥ 20 ng/mL, n = 49), and Vit D deficient group (25-OHD < 20 ng/mL, n = 115). The median age of participants was 74 years (range, 64-83 years) and 78 (40.6%) of subjects were female. Significant findings of the study are as follows:

  • Compared to the Vit D sufficient group, the Vit D deficient group experienced higher risks of initially severe stroke, measured by the NIHSS (p = 0.008) and poor outcomes on the BBS (p = 0.015), MFT (p = 0.009), K-MMSE (p = 0.001), K-MBI (p = 0.001), and mRS (p = 0.010).
  • Significant positive correlations were observed between serum Vit D levels and BBS (p = 0.006), MFT (p < 0.001), K-MMSE (p < 0.001), and K-MBI (p < 0.001) scores.
  • Multivariable analysis findings show that lower serum Vit D levels were associated with increased risks of stroke severity (p < 0.001) and poor functional outcomes based on the BBS (p = 0.025), MFT (p = 0.033), K-MMSE (p = 0.001), K-MBI (p = 0.005), and mRS (p = 0.013) scores.

Results of the study show that Vitamin D deficiency was associated with poor functional outcomes and increased risk of severe stroke compared to subjects with sufficient serum Vitamin D levels. Further research on the potential neuroprotective and cerebrovascular benefits of Vitamin D are necessary. Study limitations include potential selection bias, the small sample size, the use of only one measure of Vitamin D status, and the lack of factoring in the size, location, and etiology of AIS in patients.

Source: Kim, Min-Su, Jin San Lee, Sung Joon Chung, and Yunsoo Soh. “Association between Vitamin D and Short-Term Functional Outcomes in Acute Ischemic Stroke.” Nutrients 15, no. 23 (2023): 4957.

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://
creativecommons.org/licenses/by/4.0/).

Click here to read the full text study.

Posted January 17, 2024.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Zhang X, Wan M, Min X, et al. Circular RNA as biomarkers for acute ischemic stroke: A systematic review and meta-analysis. CNS Neurosci Ther. Aug 2023;29(8):2086-2100. doi:10.1111/cns.14220
  2. Kamal FZ, Lefter R, Jaber H, Balmus IM, Ciobica A, Iordache AC. The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options. Int J Mol Sci. Mar 28 2023;24(7)doi:10.3390/ijms24076389
  3. Nimjee SM, Akhter AS, Zakeri A, Herson PS. Sex differences in thrombosis as it affects acute ischemic stroke. Neurobiol Dis. Apr 2022;165:105647. doi:10.1016/j.nbd.2022.105647
  4. Vergatti A, Abate V, Zarrella AF, et al. 25-Hydroxy-Vitamin D and Risk of Recurrent Stroke: A Dose Response Meta-Analysis. Nutrients. Jan 18 2023;15(3)doi:10.3390/nu15030512
  5. Kamal K, Tewari J, Bharti V, et al. Serum Vitamin D Level as a Risk Factor and Prognostic Marker for Acute Ischemic Stroke: A Case-Control Study at a Tertiary Care Centre in Northern India. Cureus. Sep 2023;15(9):e46117. doi:10.7759/cureus.46117
  6. Hesami O, Iranshahi S, Shahamati SZ, Sistanizd M, Pourheidar E, Hassanpour R. The Evaluation of the Neuroprotective Effect of a Single High-Dose Vitamin D(3) in Patients with Moderate Ischemic Stroke. Stroke Res Treat. 2022;2022:8955660. doi:10.1155/2022/8955660